I’m both a veteran and critic of the Iraq War, and a staunch supporter of health-care reform. I have a question regarding possible amendments to the Baucus Bill currently being considered.

I’ve heard that legislators are considering a public-option "opt-out" measure that would allow states to reject a national public health-care system. Democrats and Republicans alike are hailing this as the only "real" way to push reform through. Now, our beloved Blue Dogs (among them my own representative, Idaho Rep. Walt Minnick) may love this, but I’m dubious. I’m a veteran who’s seen the good that "socialized" systems like TriCare can achieve, and anything less, to me, seems like a bone thrown to Big Insurance.

Where does your site stand on the "opt-out?" Are there any good sources of information on this measure? What’s to say that dyed-in-the-wool Red states such as my own won’t simply refuse to take part in a public option, thereby leaving constituents like myself out in the cold, unable to afford decent care? And why should my state get to decide whether or not my wife gets coverage for her pre-existing conditions?

That’s a very good question. First of all, while there are a lot of different voices on this site who are free to speak for themselves, but the consensus of those of us regularly covering health care that the "opt-out" is bullshit. It’s nothing but an escape hatch for a White House that has bungled health care up until now, a political exercise supported by those who want to deliver themselves from the mess they’ve made. Its supporters say that it will help them get the "60 votes" they need for the public option, which is curious because these people generally understand that the 60 vote threshold is for cloture. Not one single Senator in the Democratic caucus — not even Joe Lieberman — has said that they will join a Republican filibuster. Not one. And even Schumer himself says there are 54-56 votes for a public option, a comfortable majority for an up-or-down vote. They’ve never been able to produce 10 members of the caucus who say they will vote against one.

Jon Walker estimates that 51% of the population live in states that have GOP governors, GOP legislatures or both. Proponents of the "opt-out" say that they’ll never have the guts to do it, and point to the fun we’ll have watching them try. As evidence, they’re harumphing about the fact that, in the end, no state turned down the stimulus money–which is so far away from being an apt comparison, it’s laughable. The stimulus money was free money — the "opt out" simply removes an option from the state exchange that would compete with private industry. I could get rich in a heartbeat running campaigns in states like yours to get them to "opt out." It’s complex, difficult to understand, won’t kick in till 2013 anyway and easily subject to demagoguery. The party that brought you "death panels" will have no problem taking big checks to get rid of it, and they’ll probably have a lot of help from the other side of the aisle.

The big winner of the "opt-out" is Rahm Emanuel, who painted himself into a corner on health care. As Chris Hayes notes, liberal "veal pen" institutions were so busy taking dictation from him they didn’t communicate the fact that the Democratic base was really, really attached to the public option, and he assumed that everyone would just "suck it up" like the had the war supplemental and ACES. Now that the Senate has to come up with a bill, and advocates have been successful in making it extremely uncomfortable to ditch the public option, Rahm is desperate to fulfill the promises he made to deliver a bill without one. He whipped Blue Dog votes in the House by promising them there would be no public option in the final bill, and now that they have boatloads of health care lobbying money to make sure there isn’t one, they’re looking to him to make good on that.

So who comes to the rescue? Who charges in and suddenly decides that rather than force the issue and put the White House in the awkward position of either producing Democratic Senators willing to join a Republican filibuster or bring the public option in the HELP bill to the floor, they should be let off the hook?

Well, that would be the liberals, who quickly fanned out to let us know that it was okay to play Russian roulette with the health care of people like your wife who live in red states because it puts Rick Perry in an uncomfortable position. The people who have been clamoring about all the hideous things the GOP has done to health care suddenly step up and offer Rahm the escape hatch he’s been looking for. Because even Tom Carper — who apparently came up with this "solution" — doesn’t want to talk about it.

Democrats once again are negotiating with themselves. And who pays the price for this convenient piece of political calculus if they turn out to be wrong and insurance industry money is successful in getting red states like yours to opt out of a public option? Well, Rikyrah over at Jack & Jill Politics gives us a pretty good idea.

139 Responses
to “Liberals Help Rahm and Blue Dogs Off the Hook With “Opt-Out””

Opt-out is a good federated solution to a complex issue in a country that is sharply politically divided.

If a state decides to opt out, then it would be by that state’s democratic processes, and if the issue were that important, it would become a decisive issue in state elections, probably before 2013 when this is all supposed to spring into existence under some plans.

We can extend our hand in friendship and aid, but cannot guarantee that the other parties will extend theirs in return.

At some point, liberals need to abandon the role of “professional minders of other people’s business,” and tolerate the right of others to choose their own path as we choose ours, even if we disagree with their path, so long as it does not effect us.

I’d prefer to see single payer or national robust public option in that order, but would settle for opt-out if that would get a robust public option off the ground for a majority of states.

perhaps we should give Dixie and the Dead Zone an option to opt out – of the Union. /s

In all seriousness, if we lose healthcare reform because of the Congressional delegations of that bunch of states, people in the remaining 30 states may just come to start questioning the cost of keeping them…

It is unlikely that the GOP will sink below its current dismal levels (~30%) of support unless another, wackier right wing political organization springs into existence to sap their support.

We’d do well to prepare to live with this knot of 30% wingnuts by adopting strategies to put them out of our misery as far as policy goes, as suasion does not work with people who can retort with some variant on “God put fossils there to test our faith.”

Landrieu won’t, whatever she threatens… she almost always falls into line at the last possible minute, after she can persuasively argue to her corporate owners that she tried her best. The Great Troll of Stamford is another matter altogether. He just might do so. Out of spite.

I think you guys are being too dismissive of this merits of the opt-out proposal. First, I think Jon Walker and others are vastly overestimating the number of states that would actually opt-out. Second, I think you are all greatly overstating the degree to which citizens in opt-out states would be deprived of the benefits of the bill. From what I understand, only the public option part of the bill would be opt-out. So the citizens of opt-out states would still get the benefits of the rest of the bill (i.e., protection from denial for pre-existing conditions and subsidies to buy insurance). Moreoever, the whole point of the public option is to put pressure on private insurers to keep premiums down. And this should work even if a number of states opt out. Here’s why. Obviously in public option states, insurers will have to keep premium prices competitive with the public plan. But insurers in opt-out states would be under similar pressure. If they charge rates significantly higher than in the public option states, journalists (and Democratic politicians) will highlight the disparity. If that practice continues, there will be enormous pressure on states to opt back in. If they don’t, not only will local Democrats hammer them for it, but the business lobby will too, because the lower premiums in public option states will created a competitive disadvantage. States will opt back in if for no other reason than to keep business in the state.

There’s a lot of merit to this proposal. It gives up very litte (maybe nothing) and it accomplishes something significant, creating a robust national public option.

The entire concept an “opt-out” is a smoke and mirros distraction. First of all, an opt out makes the entire bill Constitutionally suspect and, of course if it held up under court challenge, would insitutionalize states rights nullification of any federal legislation. Secondly, whether or not the opt-out would work programatically depends ,of course, on how strong the public option in the bill was, how narrow the procedure for participation would be (legislative as opposed to referendum), and when the program would be impemented. All these variables are at the heart of the issue now and don’t change because of an opt-out.

So what must happen is stop talkin’ about an opt-out until a strong bill is produced and then see whether or not it would be necessary, politically, in order to get the bill to a vote.

As I have said in the past, the “opt-out” doesn’t change the dynamic at all of what is necessary in a bill in order to solve the problem…let’s stop arguin’ over the opt-out and get back to forcin’ a strong public option into the bill.

KEEP THE FAITH AND PASS THE AMMUNITION, AND DON’T SHOOT THE FRIENDLIES!!

The country is sharply divided because the fulcrum of American politics is so far to the left, that it takes 5 progressives or liberals to count for one conservative. Given the Senate system, those perspectives have disproportionate influence on the political process irrespective of the sentiments of the population.

We can either play that hand, or pretend we were dealt another hand and try to play it. I’d hoped we’d managed to secure the dealer’s table last November, but…we’re playing the hand we’re dealt.

How much of this is just manoeuvring before the bill goes into conference? That’s where the final shape will be determined. I’m beginning to think that the people who are going to get mouse-trapped on this one will be the Blue Dogs.

Is it time to pull out the 1981 Lee Atwater quote about how “states’ rights” and “tax cuts” are “abstractions” (or rather, code speak) standing in for “Let’s keep your tax dollars from going to help black people”?

Those are nice generalizations. It would be more helpful if you would mention specific Senators who represent this phenomenon you’re talking about. Because if you can’t count 10 members of the Democratic caucus who have definitively said they will vote against a public option, your hand falls apart.

What I said earlier @105 in the Rikryah (sp) thread – this is a repeat of Taft-Hartley.

THIS IS NOT JUST ABOUT RACE. THIS IS ABOUT MONEY AND BREAKING UNIONS, TOO. RACE PROVIDES A NICE SWEETENER FOR THE CRYPTO-RACISTS (and the not-so-cryptos, too) AMONG THE BLUE DOGS TO VOTE FOR THIS, BUT IT’S NOT THE PRIMARY MOTIVATION.

While it’s true the so-called Federalist option – allowing states to opt-out of public opton for health care – would disproportionately wind up landing on states with the largest African-American populations, in so many words repeating an injustice which bedeveiled A-A workers in those states when the same thing was done with Social Security to get it past the predecessors (also Democrats) of today’s Blue Dogs. And which took decades to redress.

What I would remind you is that such an opt-out would also replicate the “right-to-work” or “open shop” provisions of the Taft Hartley Act of 1947. State by state regulation of whether unionization was supported wound up, in thsee same Old Confederacy and border states, resulting in anti-unionism in those very states. That both undercut union organizing in those states AND facilitated the movement of union jobs from unionized Northeastern and Midwestern states to the “right to work” states, phenomena which we are still dealing with today. In so many words, it created an incentive to arbitrage labor inside the US by threatening to move the plant to the land of crackers, where saying Union could and would get you fired. This provision will merely replicate, refresh, and continue the “Rust Belt to Sun Belt” migration of jobs to the downmarket South which has been a feature of American life for the last 30 years or more.

I can see the same thing happening, particularly if there is an employer mandate in the bill – jobs will move to the states where you get crap insurance (if any) and if you want to be in a public option state, go ahead, try finding a job there.

This proposal was seriously, deeply thought-through by someone who does not have voters’ best interests at heart. It’s also the kind of thing which will garner warm bipartisan support from people like, say, Senator Corker – who I suspect could easily see his way clear to supporting a plan wihch will encourage bringing the equivalent of a new, non-healthcare, non-union Saturn plant to his state.

Big Bidness mnust be seriously pleased with the sudden approval this stupidity is gaining. (That sudden embrace, BTW, is an indicator that the liberals have no stomach for a fight.)

BTW, that Taft Hartley act was passed in 1947, and is still on the books. And, don’t forget, the Republicans passed Taft Hartley over Truman’s veto (with some Dixiecrat help, IIRC). Now, Rahm has managed (in turning the Democratic party into the Republican) to get the Democrats to do it to themselves.

right now there’s no reason why we would offer to consider this proposal or any other compromise to what is already the compromise. The House is basically there on the Strong PO with rates tied to Medicare (something like 8 more votes are needed, and Rep. Woolsey is confident about delivering those). The Senate is showing signs of sanity, with what is starting to look like a revolt of as many as five Dems on the Finance committee (that was a shocker) – remember, Finance, the ultra-conservative committee that we were supposed to lose to Baucus. Senate-wide, we’re probably at around 44 to 49 of the 50 votes we need, with enough the mercenary flip-flopping type of Dem to make up the breach if the president or leadership asserts enough pressure. Yeah, not all of these people are there for the strong PO yet, but the pressure is building and will become (if we do our jobs) unbearable by crunch time.

What you compromisers are proposing to do is tantamount to bluffing yourself in a poker game. Please stay strong. Keep calling, organizing, and speaking, and we will prevail.

Its ridiculous to put this decision in the state legislatures. I understand the potential to render those that are GOP-led ineffectual but I, for one, will not enjoy seeing the mess that this will create.

This is a compromise that brings no one on board. It adds another element which is vulnerable to being sabotaged when the actual legislative language is written. It’s just dumb that Dems are negotiating with themselves again.

I’ll tell you what. If you don’t want the Public Option, DON’T CHOOSE IT. But don’t take that choice away from your neighbor.

Jane, I am a strong supporter of your work on healthcare reform, but I think you may be missing the mark here. You only need to think back to the wail the right-wingers made over the stimulus. They were going to “tell Washington to keep their money!” How did that work out? Not one of them actually did it. From a political standpoint, this leaves the Republicans with nothing to do but sputter and spit. The public option is very popular even in “Red” states. That said, don’t stop what you’re doing. The strong push from the left is the only thing that has gotten us to within striking distance. Keep up the good work.

At some point in this process the President has gotta stand up and fight for whatever he knows is necessary to solve the problem and NOT what is necessary politically to get the bill passed. The neo-liberalism of Clinton and ObamaRhama is, essentially, politically process-oriented aimed at getting legislation passed that preserves the prerogatives of the staus quo. Time for Obama to shit or get off the pot…when the President has the support of 70% of the public on an issue, he can’t loose because those who oppose his solution own the problem.

The fulcrum is far to the left which means that there is more political terrain to the right and that the right has the mechanical, political advantage over the left. If the fulcrum were far to the right, then the left would have the advantage.

the opt out is a cop out.
no disageement there.
however, if the language in the bill demands a voter referendum in order to opt out, i’d be extremely confident that the number of states choosing to opt out would be few, if any.
for example, if the bill’s language stated that only the voters – not the governor or the legislature – could opt out, via a majority vote in that particular state, and that such a vote could only occur two -three years after the public option was in place in other states, i doubt if any state would actually make the choice to opt out.
even the brain-dead republicans in red states will recognize how important the option is – if a robust public option is instituted – and i cannot imagine that voters will actually vote to deny themselves the chance to participate.
i’m somewhat surprised that so many supporters of the public option have so little faith that it will actually work and that it will be attractive to voters.
again, the most important issue is WHO gets to make the decision. if a governor is simply able to make that choice, or if a legislative body can make that choice, pessimism might be warranted.
however, if voters get to make the choice – and it’s up to liberals to make sure that the appropriate language is in the bill – i think it is an excellent way to resolve an extraordinarily difficult situation.
a situation made so difficult because obama has never really intended to actually have a public option in the final bill. with the opt out solution, he’s now going to have to explain how it got there to his paymasters in the health insurance racket.

Jane, would we be going through these contortionist gymnastics were the votes in place to pass a robust public option?

If there are the votes for a robust public option nationwide, go for it!

But if there are not, then we need to get what we can when we can.

There is a sentiment amongst the left that unless we can take everyone along on every policy, that we should take nobody along on no policies. This happened with ENDA in 2007, LGB don’t get workplace protections until T gets their political support together.

Had that position prevailed, then blacks would have had to wait for women who would have had to wait for queers, etc. Medicare would never have been enacted because it does not cover everyone.

In politics, doors and windows open and shut, and the only way to make progress is to plow through them with as much as you can muster when they are open, before they close.

Actually it is Senate Democrats who are negotiating with themselves. Or maybe it’s just confined to the Senate Finance Commitee.

Exactly how will this grand compromise be introduced? As an amendment to the Senate Finance Committee bill? As part of the HELP committee-Finance committee reconciliation on the bill to send to the floor? As an amendment on the floor?

So what if I work in a state that opts-out and my employer is headquartered in a state that opts-in? What do I do? My employer has already negotiatied there new rates with our Insurance company. The rates are 2 million dollars higher this year than last. My employer is going to absorb those costs this year at the expense of adding employees and expanding products, etc… I bet if CIGNA was competing with a robust public plan, they might find a way to keep those premiums flat.

see my response to #26. what evidence do you have that we won’t have the votes we need in the end? I’m, actually feeling pretty good about this.. much better than I did last week. Sometimes I think that some of us want healthcare reform to fail in order to make some type of ideological point or to take revenge on the president y’all wanted, or somethin’….

so much for being teddy’s BFF.
asked how he would vote on the baucus bill, O hatch on fox said he would oppose it and then attacked health care reform, saying Baucus bill will gut medicare.
scare scare scare.

Something about the the absence of evidence not being evidence of absence comes to mind.

I voted Democrat for President for the first time since 1992 in 2008. The President has done nothing to stop working Americans from failing in this economic crisis, so I’m not too worried about sucking it in further to prevent this President from failing when success for him means failure for so many.

The policies are all that count, and maintaining the political momentum to push the envelope further. If that’s not part of the deal, then our side is not playing for keeps, and they cannot expect unconditional reciprocation.

The competitive pressure for states to opt back in, after opting out, is unlikely to materialize. The assumption is that competition will push prices down, but the incentive structure will induce private insurers to evade the regulations and push consumers out of coverage. The public option is their escape valve, and not having it makes a difference.

The WaPo had an excellent article earlier this week, making a point I’ve been making, that the private insures will use selective marketing, administrative hassles and poor service to discourage the higher-cost (usually older) patients. If the PO is present, they will tend to move towards the PO, which will also tend to drive up it’s costs/prices. That will be a problem, unless the risk-sharing arrangements work perfectly (but they won’t and you can bet the insurers will be lobbying on the inside to make sure HHS doesn’t enforce them).

But if the PO is not present, then those discouraged by the insurers’ tactics will have no place left to go. The insurers will maximize the 4:1 ratio allowed for charging higher premiums to older people, and they’ll get screwed or be pushed out of the system. The private insurers will settle into controlled competition with no pressure from a PO demanding the insurers abide by the rules against discrimination and fork over the correct amount of risk sharing dollars.

You can’t judge this proposal by assuming insurers will play fair and the logic will just convince people to do the right thing; you have to design a system knowing that people have powerful incentives to cheat and manipulate the rules and how the results are reported. High-risk consumers will be screwed, regulators will be misled, and the public will not know how it happened.

David Boies: So I think one of the things we would be urging the United States Supreme Court is that this is a matter of state law, state law is deserving of deference, and that the United States Supreme Court ought not to step in and substitute its judgment as to what the intent of the voter was for the judgment of the state officials that, under law, have that obligation.

Thanks for this post Jane. Liberal Dems trying to sell opt out to the public is at best grasping at straws. To me though it clearly demonstrates a total failure of Democrat leadership.

The public wants a real public option available to everyone. The Dems campaigned on that. If they fail to deliver it to everyone, they will have failed. Again.

If opting out is such a swell idea, why don’t we do it for every single piece of legislation that is passed? If my state doesn’t want to participate in some of the more egregious aspects of the Patriot Act, we should be able to opt out. If we don’t want our taxes spent on endless wars, we should be able to opt out. We could go on all day like this. Opting out on a basic civil/human right is unacceptable. We shouldn’t be willing to sacrifice the lives of others on a state-by-state basis. It was a devil’s bargain with slavery. It is a devil’s bargain now.

If opting out is such a swell idea, why don’t we do it for every single piece of legislation that is passed? If my state doesn’t want to participate in some of the more egregious aspects of the Patriot Act, we should be able to opt out. If we don’t want our taxes spent on endless wars, we should be able to opt out.

This works for me, and seems much more civilized than living in a shotgun marriage with irrational wing nuts and having to dumb our policies down to their level.

When one-size fits all, you don’t get anything resembling a tailored solution.

Imagine if CA and NY were able to withhold our taxes from the Pentagon, NSA and CIA? Bring that shit on!

Obama WH failure regarding Single Payer deletion has been compounded by a thinly veiled desire to not see any truly viable and effective Federal Health Insurance Choice formed up and taking place.

Barack Obama considers Max Baucus a political buddy for Mary’s Son sake!

Letting WH creatures like Rahm Emanuel run the WH political cattle drive and doing deals with the enemy to placate the money politics people in Obama WH two very real tells on where Barack Obama is on PO.

Letting fifty states shape or distort any PO outcomes is invitation to statehouse lobby money politics of the most greasy sort. State capitals are easy targets for well funded money politics. Incredibly bad idea.

At this point it really would be better to let 2010 election cycle sort out who the skunks and rats are and let 2010 elections shape what takes place in years 2011 and 2012.

There is little need to rush this or create fake deadlines here in late 2009 when 2013 is being held out as the start-up year. There has been six decades of delay if one starts with Truman WH years as it is anyway. Any timeclock pressure or fake time restraints imposed here in late 2009 is pure hokum and a ploy to stampede the cattle drive politics taking place.

Let 2010 elections put the pressure on and vote out the skunks and rats.

First, I think Jon Walker and others are vastly overestimating the number of states that would actually opt-out.

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NOT ME.

The GOP is in a perpetual war of spite across the aisle. WAR.

My state’s GOPer pols are in lockstep with their RNC playbook and they never do anything that puts public good (as defined by rational people) over capital/corporate lobby monies. That may not be true in other states but it does skew any guesswork that favors a “logical” expectation that states are impervious to national political trends and mandates.

Your comment seems to be saying that because the White House and Senate leadership are spineless, it is necessary for the Dems to negotiate with themselves: “We’ve got to pander to the right, giving them what they want, even though they will never vote for the end result, because we don’t have enough fortitude to simply put together what we want and push it through.”

To THEM, it may feel necessary. To vertebrates, on the other hand, it seems rather silly.

Howard Dean tried to get the conversation back to what would be in the final bill and away from the tactics or language that would be used to get the proposal to a vote. The entire concept of “opt-out” is a distraction…if a good bill comes out and the “opt-out” is used to get it to a vote, then the angel has wings. If, on the other hand, the “opt-out” is used to get an unworkable, bad bill to a vote then it’s just lipstick on a pig.

Yesterday at Kos there was a diary about this with an avalance of comments.

The main arguments for it seemed to be that 1) red states that took stimulus money would feel the same pressure to stay opted-in on the public plan, or that 2) when southern voters saw the harm that a “small number” of right wingers were doing them, they would see the light and become liberals and, most memorably, 3) why should blue states do without health care just because red state politicans block it

I’m in Atlanta. The brunt of this will obviously fall on blacks. I made that very observation in one of my comments and got almost no recommeds from Kossacks. Not what they want to hear I guess. I also find it disturbing that Kossaks think racist right wingers are a tiny minority in the white south.

I will give a disheartened tip of the hat to whichever opposition strategists came up with this one. As divide-and-conquer tactics go, this one is murderously effective.

it accomplishes something significant, creating a robust national public option.

Dream the fuck on.

You know what creates a robust national public option? A fucking NATIONAL PUBLIC OPTION. This is the same as leading off with your compromise. This is the same as saying instead of doing.

And don’t think this will only effect the Old Dominion. It’s not at all clear which states could get turned by insurance industry/Repub money and loudness. Thinking that pressure from the media and Dems would cause any state to re-opt in after opting out is just starry-eyed dreaming. Counting on pressure from businesses to force re-opting injust supports the fact that universal availability is good fucking idea. So instead of wasting time giving Teabaggers and insurance industry whores and Republican demagogues years to poison our well, and kicking the can of responsibility down the road to the states, let’s just do it now, ok?

On another note, if red states do opt out, the rethugs everywhere won’t be able to get elected dog catcher. Because WE, in the slavery states will raise all kinds of hell if our governor or legislature opts out and leaves us with shit. Webb, Warner, Perriello, Scott will hear from us on an hourly basis. That is if we’re not dead due to no healthcare or insurance.

1. Combine it with a trigger
2. Phase it in so slowly lobbyists can nibble it to death
3. Let it devolve into a Red state PO and a Blue state PO
4. Let states pick and choose which provisions they want to opt-out of
5. Let states opt out of all health care reform entirely
6. Let individual congressional districts opt out creating administrative nightmare
7. I’m sure the lobbyists will think of more…

huh???? I’m the guy who never liked Obama remember? who inveighed against him here all during the elections? y’all got him elected. Now please don’t stop the rest of us from getting policy done, with the president y’all gave us to work with. And now you want him to fail because he let you down? Please, sir, drop your baggage.

I sincerely believe that we are within striking distance of getting an acceptable PO and hence a healthcare reform measure that this country desperately needs, without further compromises on its basic structure. Please work to help us get this done.

In the end, ObamaRhama owns whatever comes out of the procress and that is what is wrong with focusin’ on tactics to get legislation to a vote as opposed to keepin’ the eyes on the prize of what is in the bill. The “opt-out” is a tactic (albeit one that might make the entire bill unconstitutional) to get a bill to a vote…the problem still exists as to what is in the final bill. ObamaRhama knows that in the end, if a good bill is produced even if it fails, the administration and the people win and if a bad bill is produced the administration and the people loose.

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mcjoan was making nice with it as was most everyone else yesterday besides Chris Bowers. That was yesterday. I think there’s been some sleeping on the idea and some change of heart.

Ed Schultz was great last night. Wyden was on teevee on MSNBC this morning too with the message that even though he won’t talk about how his buds fucked him over in committee, there’s gonna be some muscle in the full Senate and House process to give us a real choice, not optional choice.

I see a future with “opt-out” in which we have sick states and healthy states. People with serious medical needs will move to states with public options while the young and healthy move to the south. Is this a good idea?

LOL, oh yeah that will work out great. Where we now have one country, we will have 50 new ones (plus some independent territories) each with their own budget and legal system. What you are advocating is the dissolution of the federal government and the United States as an entity along with it. Go knock yourself out.

I believe that her suggestion was that you are misusing the word “necessary”

Because it would make something easier does not make a thing necessary. On this opt out provision specifically, what do you think makes it necessary? As others have noted here and elsewhere, it doesn’t add any R votes, and there are at least 51 aye votes for a public option without opt out.

At this point, as a Liberal and core Democratic voter, I expect the party to man up and do what it should have done from the start. No more compromises.

I don’t think I’m alone, either. The people have had to force real reform on their representatives one step at a time. Now, when the momentum seems irresistable and the bulk of Democratic representatives sem to be panicked into doing the right thing, the party leadership wants to try to put the brakes on? Why?

I suspect that Lincoln was right: you can’t fool all of the people all of the time. People don’t appear to be fooled now, and pretty much any compromise is going to hurt support for incumbent Democrats. In fact, the procrastination, evasion, cowardice, and dishonesty that has distinguished Democratic pols in the healthcare debate has probably already cost them, no matter what they do. So why compound the damage, when they have a chance to wear the white hats and take credit at the start of the next campaign cycle?

Big insurance companies and big pharma have, after all, already shelled out bigtime on behalf of blue doggish Democrats. Isn’t taking the cash and then doing the right thing a win/win for the dogs, particularly since doing so weakens the donors financially should they turn out for the Republicans later? Why honor an immoral backroom deal when you can take the cash, be a hero, and screw the other guy badly enough that he can’t retaliate?

he. Good point. I’m kidding here, but at some level I really do think that if they want an opt out from American public policy they should just opt out of the country altogether. I’m kidding of course, but perhaps there is a letter from Charleston dated December 20, 1860 we can dust off and finally decide to honor…

how many seniors, even in red states, refuse to participate in medicare?
remember “keep the goverment’s hands off my medicare”?
what makes anyone believe that red state voters – given the chance to vote via referendum, which is crucial, rather than letting a governor or lawmakers make the decision – would choose to opt out of a health care option that would be similar to medicare.
lots of folks who live in places like alabama and louisiana may be racist and backwards in lots of ways – that much is obvious by looking at the people they vote into office – but they are not entirely stupid and crazy.
given a choice, they’d hold their nose and vote to opt in, even if they had to lie to some of their friends about how they voted.
this is a decent way to resolve this mess – made so by obama’s duplicity and his reneging on campaign promises – and, imho, the most important thing to do now is to make sure that any opt out is only done by way of referendum, and that such a vote can only happen after the public plan has been in place for a few years.
opting out of a theoretical program that has not been instituted is one thing.
saying no to a popular, effective health care option that the guys who live in the state next door enjoy is an entirely different matter.

Phred, There have always been federalist tensions in the US, and at this point, it seems that the US is dissolving on its own volition.

It seems that whenever conservatives fart out some incoherent objection to their tax dollars being spent, say for reproductive services in this bill, their needs are met instantly and without substantive debate. I just want to see equal time for all comers who object to criminal uses of tax dollars. Can we start with letting states opt out of war crimes against (formerly) living humans if the government is going to cater to the needs of those who fetishize the unborn?

I admit my first reaction to the opt-out proposal was preemptive schadenfreude. I too wanted to see the whores of the insurance cartel just try to deny the PO to individual states. I thought they’d never be able to do it, and their foul loyalties would be exposed once and for all.

How naive. This post has put me back into the no opt-out, no way column for 2 reasons:

1. (the less important reason) The instant opt-out becomes the law, $$$ will drain away from health care and into lobbying machines all over the country as the insurance cartel fights to maintain turf.

2. Most important reason not to support opt out: It isn’t necessary.

As Jane says, it’s handing an undeserved win to Rahm, just when he was about to suffer a well-deserved failure.

Peterr, I guess I’m worried that we’ve reached the limits of how far the progressive grassroots can push the public option. At some point, particularly when the bill goes into conference, this thing will be decided behind closed doors. And that’s when the question of a robust public option, opt-out, or a truly crappy proposal that helps no one, like triggers or co-ops, will be decided. So in that light, the whole thing will be in the hands of the WH and Congress leadership. Do you trust them to come through with a real public option? If you do, you’re more optimistic than me.

Like I said, I’d love to be proved wrong. But I worry that if we don’t take the opt-out, we get something even worse.

Listen to Howard Dean and stop wastin’ time and energy arguin’ over what is essentially a tactic and re-focus on what is in the final bill. Obama is NOT stupid and even if he were to get a bad bill passed that wouldn’t take effect until 2013, he knows he and the American people loose. The point has long ago been reached that what is in the final bill even if it fails to pass, wins politically for Obama and he knows it.

Our efforts and meager resources need to be targeted on the House of Representatives. If a strong Medicare plus bill get to the floor of the House it drives the debate in the Senate. This is and always has been a race between the House and Senate to determine the content of the final product. Pelosi has tried to give One Hung Harry Reid all the time and space he needs and he seems determined to stall until the House acts.

Like I’ve been sayin’ all along, this entire battle hangs on the fight between the progressives in the House and the leadership. Let’s not be distracted.

KEEP THE FAITH AND PASS THE AMMUNITION, IF YOU’RE NOT LOOKIN’ AT IT YOU PROBABLY WON’T HIT IT!!!

Knock out health insurance and you’ve still got home ownership impeding labor mobility.

The young prefer to live in places with interesting things to do and that have a healthy gene pool for them to swim in.

When was the last time you heard the addage “go south, young wo/man?”

As far as my experience, there was no finer sight than when 20 years ago on Sep 30, I drove my laden pickup truck north on I-25 out of El Paso, and saw “You are now entering Texas” reversed in my rear view mirror, getting smaller and smaller.

1) This proposal has the libs’ shorts all in a wad… and we’re talking about a FRIGGING PUBLIC OPTION that will only be available to 5-7% of the population! If states decide to “opt out” this is not going to be a big hit to anyone anywhere anyway.

2) I believe that there won’t actually be many states “opting out” due to the hue and cry from the public on a state by state basis. I actually think it’s a good thing to push this down to the state level (and I decry using the inflammatory “states right” meme to color this proposal) because the people will have much more of a say than at the federal level. The bastards that are supposed to represent us will be called much more to task if it’s on a state by state basis… and the ill-informed populace will probably become more engaged if it’s a state issue.

3) Apparently, according to hill folks, this proposal is not seriously being debated right now anyway because no amendments were put forth with the opt-out clause… if we get to the point were the very weak, nearly lifeless public option causes big problems, imho, the PO opt-out could be a viable solution.

4) IIRC, isn’t this the way Canada initially got healthcare for all? Province by province as people began to see the merits?

No way, now how. Economically speaking, the only way I can see a state opt-out working is if we have immigration and commerce (Trading with the Enemy?) controls with the states that opt out. Probably limits on taxation retroprocity to, hmm, ya know, if you put it that way, maybe is a silver lining in those whole opt out thing after all… … ;-P

I feel like I’ve fallen into a time warp to the 1950’s. I guess there is no arguing with antiquated thought processes.
I’ll say this if you believe a 45 year old man with a serious medical problem won’t move from Georgia to Illinois to get affordable health care and that a healthy 20 something won’t move to Georgia to fill a a vacant position then you have never been sick or young.

The young are not rich, at least I was not rich when I was young, and cannot afford to pick up and move in general, especially if they’re not college educated. If they are college educated and more mobile, they are more likely to have workplace based insurance and not need to move.

What are the percentages of Americans who never leave their home county?

The converse is true, however, that people will move from health care poor states to health care rich states. I have no problem with that.

It is one thing to move to save a few bucks, and quite another to move to save your life.

That suggests that the strategy that Jane has been pushing to get progressives in the house to vote against a bill that has no public option gives Pelosi and the House leadership a very strong position when that conference committee meets. Caving in to a bad pseudo-compromise BEFORE THE SENATE EVEN APPROVES ANYTHING is not the way to shape policy.

Can anyone explain why I shouldn’t expect to see a coordinated Rovian effort to amend state constitutions to ban marriage between animal-human hybrids and meta-human replicants on the same ballot with the public option hokey-pokey?

True but I bet the GOP insists the vote be held in a Non Presidential year election the GOP thinks they will win the turnout war then. And if nothing is done about Jobs, Homes, or ending the wars they might win.

Frankly, I really don’t get the negativity over this before any details are actually known. I don’t understand the “shoot the moon” atitude which may result in nothing. Why not wait to find out before trying to destroy it? Even these estimates on who would not have access initially are based on a number of WAG’s.

Lets turn this around suppose we have a National vote full healthcare now for everyone drug prices brought in line with Canada and Mexico.
A second Option the Public Option
A third Option what ever the Blue dogs want
Our ideas their ideas and a compromise all represented
Everything paid for by a tax on the rich especially media companies that lied us into war (I call it the Judy Miller tax).
The GOP wants a popular vote fine but only if we give people a chance to vote on our real option not just the GOP option and our compromise option.
Plus I want a National vote on limiting CEO pay. And a vote on trying Bush as a war criminal.
We can play the populist card better than they can if we want too.

I think the concern I have here is that we’re proposing to entertain a compromise (half-baked or not) while the real deal is still on the table. That’s the very definition of negotiating with oneself. Until someone shows us, decisively, that the strong (national, no opt-out, no trigger, no co-op) PO is definitively dead, then we should be pushing forward.. and things don’t look particularly grim for that deal now. I’m just saying that we should not fall pray to “bright-shiny-object” syndrome.

You’re complexifying the argument unnecessarily in order to shoot it down. Stimulus money and access to a public option are both supposedly things of great value. (I have my doubts wrt the PO, but you certainly don’t.) Politicians withhold things of great value from their constituents at their peril. What’s not to understand?

that’s what I’m thinking.. a few conservadems and rethugs got together to come up with yet another bright-shiny-object that they’ll never end up supporting anyway. We’ve been here before in this process, and some of our Congresscritters and our activists fall for it every time.

I wonder if The Opt-Out could prod conservative states to move their own elected officials in a more progressive direction. If Red governors/legislators insist on allowing only for profit healthcare, maybe those voters will decide to vote more Blue – or as in SC, the Gov could be forced by law to allow their citizens to partake?

The public option requires a significant number of participants, and this is a way to limit participation. It harms the entire nation.

If opt-in provides 75-80% of the participation in a public option with national buying scope as a national public option for all would, then that is enough market muscle to do the trick. Aside from Texas and Florida, most of the states in Jesusland are small. The 8 other superstates would not opt out, and it is no done deal that Florida would.

Opt-out…? I suppose those in the red states will raise holy hell with their elected officials..if the rest of the states have good inexpensive health care…and the red states are missing out on “federal funds” and subsidies for their Health Care program..won’t be long before either there are no doctors or “taxpayers” left in those states…maybe they would all be moving to the “blue states” to cash in…? As for Rahm Emanuel..and his blue dog coalition..I don’t remember Rahm Emanuel’s name on any ballot last November…I sure as hell wouldn’t have voted for Rahm Emanuel, who appears to be just another “status quo” Corporatist lapdog………. if you are not a progressive..then you must be a regressive…!

I don’t want my red-state legislature and my GOP governor to decide that I don’t need affordable health insurance. I don’t want rich carpetbaggers coming in to convince my shall-we-say “easily persuadable” fellow citizens that the public option is socialism and therefore we need to opt out of it.

I saw the same thing happen with the Orwellian “right to work” law and Ward Connerly’s “Civil rights initiative”.

Hell, when it came to Connerly’s ballot proposal, even the corporate centered Lincoln Journal star and the reactionary Omaha World-Herald wrote op-eds against it, and it still passed. So, no more affirmative action for my state.

The truth is that big money and loud megaphones almost always trump the needs of a disinterested and uninformed or misinformed populace.

Opt out allows for a discussion & ultimately inclusion of on a real public option, provides cover the weak kneed democractic Senators protecting their instate health insurance industry, and give up little. Rather than endlessly discuss how weak or strong the public option should be, the discussion is over the details of the opt out. A strong public option can be pushed hard and those who are dismayed can be told to opt out.

Red state or not, no rational state politician will work to deny his voters the benefits of a public option, and those who do will be thrown out by the voters. It would be like denying your state stimulus funding. It will be all right wing talk and no action.

This opt out is a Trojan Horse for progressives, and if there must be a compromise this is the one I could support. Two things must be included, a state opting out must still mandate insurance coverage (this acts a further disincentive to opt out) and the timing of the opt out must conincide with the timing of the public option availability. NO opting out three years before implementation of a public plan, people need to be aware of what their grandstanding right wing nuts are denying them. I’d prefer they speed up availability of the public plan, end of 2011 at the latest.

Yes it will move red states to elect bluer politicans if the right wing nuts opt out. I sincerely doubt the right wing has the nerve once a public option is created. And I know a public plan that includes NY, CA, IL, OH, WI, MN, New England, PA, MD, NJ, OR, WA, HI, NM, CO, will more than do the trick.

If Blue State Democrats throw all of us Act Blue-contributing Red State progressives under the bus as their last-minute sellout to Rahm, they can bet their asses we’ll remember it next campaign. And they can ”take that to the bank” (or not), as the saying goes.

Indeed. The only reason to compromise is to get it passed.
If we’ve got the votes then let’s just pass it.

The quarterback goes back, looks for an open receiver…spots a receiver streaking down the *Left* side of the field, there goes the pass…it’s a long one………and it’s caught. OMG, that was amazing, right over the shoulder in stride and he’s clear to run it in for a score. Wooohooo!

The trend was (and is) clearly in the Left direction, but the founders decided we shouldn’t change too quickly, so they staggered Senate elections. It takes a sustained change in the country to really move that body.

Enough! I have seen these red states act dumber than dog droppings for way too long. (Over 30 years) And I KNOW — I grew up in a red state. And I left. Every citizen’s right. But if you CHOOSE to stay in the red state, you get what you deserve. ELECTIONS HAVE CONSEQUENCES. Duh!

If Opt-Out is the only way for sane Americans to get an option, so be it. I’ll take the sane plan, in California, and let my friends and relatives in Oklahoma live with their decision to stay there.

And by the way, to this day, friends and relatives in Oklahoma tell me I was a fool to move to CA. Senile, or mentally retarded? Take your pick.

Marcos, There is no “robust” public option being considered, as you well know. The only public options in the bill in the House, and the bill in the HELP committee of the Senate are public in name only. They allow only state by state plans run by the same private insurers that are big players in that state’s current private health insurance. The plans would have some defined minimum coverage, and depending on which one you’re discussing, some federal subsidies, but they would suck up the same exhorbitant administrative costs as private plans do now limiting how many subsidized people our taxes could afford to cover. These plans would also do nothing to limit the total (gov’t + private) premiums, and we can predict w/ the cos.’s strong lobbies those would increase precipitously. [BTW, who's stopping these thieves from using the premiums paid them by the insured to work against their customers' interests. Now there's something that needs passing.]

So you are offering a straw man argument that if we accept an opt-out, we’ll get a “robust” public option. Until you can show it to me, I see absolutely no reason to entertain such a likely disastrous provision.

The problem is that Baucus’s Finance Committee’s bill includes no public option at all. That shouldn’t be a problem for the American people as there are the votes for one to be added on the Senate floor as an amendment, but as Jane says, it is apparently a political embarrassment.

At this point, I think most U.S. citizens (according to polls) would like to tell the operatives to just suck it up.

Why don’t we just let some states opt out of civil rights laws as well?

Can you imagine if during the civil rights era, the only way to get a civil rights bill passed was to let certain states opt out? Let certain states continue to have their citizens discriminated against so the bill would pass?

This is as dumb as it comes, and scary for the future.

What a precedent!

But I am sure Rahm doesn’t give a shit.

But since I live in a red state and since my 25 year old daughter does not have health care, nor does her boyfriend, nor did my granddaughter for several weeks, nor does my son-in-law for a couple more months (while he is in a waiting period with his new job), this just pisses me off that some of our progressive friends in the safe states would sell the rest of us down the river.

I would like to believe that most states would fall in line and offer the public option, but there are some real hard-headed Republicans in this land who have proven they just don’t give a shit about most of America. I think putting my health in their hands would not be much better than putting my health in the hands of insurance companies.

One more thought. Would it even be constitutional? Should the legislature of one state be permitted to deny its citizens a federal right while another state’s legislature permits its citizens to have the same federal right?

In this health care fight, we’ve got a big, big problem. It starts with the fact that although an overwhelming majority of the population–in all states–tell the opinion pollsters that they support a public option. Great. In the blue states, that support generally translates into actually electing and putting pressure on our elected officials to vote for it. But in the red states, those citizens have ducked responsibility. Even though they may say they support the public option, they have elected Republican bozos who stonewall HCR every step of the way. And they continue to ALLOW their elected representatives to do so, and to act against their own best interests. It’s some bizarre combination of stupidity and hypocrisy.
Adults in red states, no matter how desperate or impoverished, are perfectly capable of voting and lobbying. There are many examples in our history of them doing so when they were pissed enough about something. So if there are so many people who want and need the public option in red states, are they not acting like they do and holding their legislators accountable in the way blue staters are mostly doing? This is a much bigger issue than corrupt insurance companies and stubborn Repubs and Blue Dogs, because it reflects a failure of citizens’ political will.
I’d go even further and call it freeloading. If red state citizens who want the public option continue to allow a small minority to dominate the debate, and the public option goes down nationwide because of it, that’s unconscionable. If we’re able to get a nationwide public option–which seems seriously in question now–it will be because blue staters did the heavy lifting and therefore those red state citizens will get something that they either opposed or simply failed to show up for.
The opt out solution works because it places civic responsibility squarely on the red state citizens to fight for the po if they really want it. And further, it gives Dems and others a magnificent organizing tool, the likes of which they’ve never seen before, to get rid of their Repub idiots.